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Cabañas Poy MJ, Montoro Ronsano JB, Castillo Salinas F, Martín-Begué N, Clemente Bautista S, Gorgas Torner MQ. Comparative effectiveness of two lipid emulsions in preventing retinopathy of prematurity in preterm infants requiring parenteral nutrition. FARMACIA HOSPITALARIA 2024; 48:159-163. [PMID: 38556369 DOI: 10.1016/j.farma.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/11/2023] [Accepted: 10/13/2023] [Indexed: 04/02/2024] Open
Abstract
OBJECTIVES The main aim was to compare the effects of 2 parenteral lipid emulsions on retinopathy of prematurity (ROP) incidence, severity, and need for treatment. Secondary aim was to compare the effect on weight gain in the first 6 weeks of life. METHODS Single-center, observational, retrospective study analyzing preterm infants with a gestational age (GA) <31 weeks and a birth weight <1251 g born between April 2015 and December 2018. The infants' medical records were reviewed to collect clinical data. Parenteral nutrition (PN) details were obtained from the hospital pharmacy database. RESULTS In total, 180 patients were included: 90 received ClinOleic® and 90 received SMOFlipid®. No significant differences were observed for the incidence of ROP (40% in ClinOleic® group and 41% in SMOFlipid® group, p=.88) or ROP requiring treatment (4% and 10%, respectively, p=.152). Weekly weight gain was similar in the 2 groups. CONCLUSIONS This study showed no difference between the 2 groups regarding ROP, ROP requiring treatment, or weekly weight gain in the first 6 weeks of life.
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Affiliation(s)
- Mª José Cabañas Poy
- Servicio de Farmacia, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
| | | | | | - Nieves Martín-Begué
- Unidad de Oftalmología Pediátrica, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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Cabañas Poy MJ, Montoro Ronsano JB, Castillo Salinas F, Martín-Begué N, Clemente Bautista S, Gorgas Torner MQ. Comparative effectiveness of two lipid emulsions in preventing retinopathy of prematurity in preterm infants requiring parenteral nutrition. FARMACIA HOSPITALARIA 2024; 48:T159-T163. [PMID: 38772807 DOI: 10.1016/j.farma.2024.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/11/2023] [Accepted: 10/13/2023] [Indexed: 05/23/2024] Open
Abstract
OBJECTIVES The main aim was to compare the effects of two parenteral lipid emulsions on retinopathy of prematurity (ROP) incidence, severity, and need for treatment. Secondary aim was to compare the effect on weight gain in the first 6 weeks of life. METHODS Single-center, observational, retrospective study analyzing preterm infants with a gestational age < 31 weeks and a birth weight < 1,251 g, born between April 2015 and December 2018. The infants' medical records were reviewed to collect clinical data. Parenteral nutrition details were obtained from the hospital pharmacy database. RESULTS In total, 180 patients were included: 90 received ClinOleic® and 90 received SMOFlipid®. No significant differences were observed for the incidence of ROP (40% in ClinOleic® group and 41% in SMOFlipid® group, p=0.88) or ROP requiring treatment (4% and 10% respectively, p=0.152). Weekly weight gain was similar in the two groups. CONCLUSIONS This study showed no difference between the two groups regarding ROP, ROP requiring treatment or weekly weight gain in the first 6 weeks of life.
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Affiliation(s)
- M José Cabañas Poy
- Servicio de Farmacia, Hospital Universitari Vall d'Hebron, Barcelona, España.
| | | | | | - Nieves Martín-Begué
- Unidad de Oftalmología Pediátrica, Hospital Universitari Vall d'Hebron, Barcelona, España
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Li X, Chen L, Lv HF, Zhao R, Ying MF, Wei L, Zhang Y, Jiang Z. Association between two different lipid injectable emulsions and parenteral nutrition-associated cholestasis in very low birth weight infants: A retrospective cohort study. JPEN J Parenter Enteral Nutr 2024; 48:345-353. [PMID: 38062851 DOI: 10.1002/jpen.2588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/20/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Using soybean oil-based lipid emulsions (Intralipid), which contain higher amounts of ω-6 fatty acids and phytosterols in parenteral nutrition, is a risk factor for cholestasis (parenteral nutrition-associated cholestasis [PNAC]). An alternative form of a mixed lipid emulsion (SMOFlipid) has been developed to reduce the risk of PNAC, but significant benefits over Intralipid in very low birth weight (VLBW) infants have yet to be demonstrated. The aim of this study was to compare the differences in PNAC incidence in VLBW infants receiving SMOFlipid vs Intralipid. METHODS The study was conducted in Sir Run Run Shaw Hospital of the Zhejiang University School of Medicine, Hangzhou, China, from January 2016 to March 2022. In total, 235 VLBW infants were administered SMOFlipid or Intralipid for ≥21 days and were included in the study. The primary outcome was the incidence of PNAC. Secondary outcomes included bronchopulmonary dysplasia, retinopathy of prematurity, necrotizing enterocolitis, late-onset sepsis, length of stay, weight 28 days after birth, severity of PNAC, and the time to reversal of PNAC. RESULTS Forty-four VLBW infants (35.5%) in the SMOFlipid group vs 41 (36.9%) in the Intralipid group achieved PNAC (P = 0.817). The subgroup analysis showed that the peak direct bilirubin level was lower (median [interquartile range] 55.6 [36.4] vs 118.4 [77.2] μmol/L; P < 0.001), and the time to reversal of PNAC was shorter (44 [49] vs 96 [61]; P < 0.001) in the SMOFlipid group than in the Intralipid group. CONCLUSION SMOFlipid may represent a better alternative for VLBW infants who require prolonged parenteral nutrition.
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Affiliation(s)
- Xing Li
- Department of Pharmacy, Qiantang Campus, Sir Run Run Shaw Hospital, College of Medicine, Hangzhou Qiantang Hospital, Zhejiang University, Hangzhou, China
| | - Ling Chen
- Department of Clinical Pharmacy, Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hai-Feng Lv
- School of Pharmacy, Hangzhou Medical College, Hangzhou, China
| | - Rui Zhao
- Department of Pharmacy, Qiantang Campus, Sir Run Run Shaw Hospital, College of Medicine, Hangzhou Qiantang Hospital, Zhejiang University, Hangzhou, China
| | - Miao-Fa Ying
- Department of Pharmacy, Qiantang Campus, Sir Run Run Shaw Hospital, College of Medicine, Hangzhou Qiantang Hospital, Zhejiang University, Hangzhou, China
| | - Li Wei
- Department of Neonatal Intensive Care Unit, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Ye Zhang
- Department of Neonatal Intensive Care Unit, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Zhou Jiang
- Department of Neonatal Intensive Care Unit, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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Zhang ZX, Yang Q, Shen W, Song SY, Yang D, Song SR, Zhang YJ, Xie JB, Tang LX, Kong J, Bai RM, Yu WT, Zhang J, Tong XM, Wu F, Li ZK, Mao J, Lin XZ. Effect of SMOF lipid emulsion on physical growth and extrauterine growth retardation in very preterm infants: Insights from a multicenter retrospective cohort study. Nutrition 2023; 116:112221. [PMID: 37832169 DOI: 10.1016/j.nut.2023.112221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/03/2023] [Accepted: 09/07/2023] [Indexed: 10/15/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the effects of soybean, medium-chain triacylglycerols (MCTs), olive oil, and fish oil (SMOF) on short-term clinical outcomes, physical growth, and extrauterine growth retardation (EUGR) in very preterm infants. METHODS This was a multicenter retrospective cohort study of very preterm infants hospitalized in neonatal intensive care units at five tertiary hospitals in China between January 2021 and December 2021. According to the type of fat emulsion used in parenteral nutrition (PN), eligible very preterm infants were divided into the MCTs/long-chain triacylglycerol (MCT/LCT) group and SMOF group. Change in weight z-score (weight Δz) between measurements at birth and at 36 wk of postmenstrual age or at discharge, the incidence of EUGR, and short-term clinical outcomes between the two groups were compared and analyzed. RESULTS We enrolled 409 very preterm infants, including 205 in the MCT/LCT group and 204 in the SMOF group. Univariate analysis showed that infants in the SMOF group had significantly longer duration of invasive mechanical ventilation and PN, longer days to reach total enteral nutrition, and a higher proportion of maximum weight loss than those in MCT/LCT group (all P < 0.05). After adjusting for the confounding variables, multifactorial logistic regression analysis of short-term clinical outcomes showed that SMOF had protective effects on PN-associated cholestasis (odds ratio [OR], 0.470; 95% confidence interval [CI], 0.266-0.831) and metabolic bone disease of prematurity (OR, 0.263; 95% CI, 0.078-0.880). Additionally, SMOF was an independent risk factor for lower weight growth velocity (β = -0.733; 95% CI, -1.452 to -0.015) but had no effect on the incidence of EUGR (OR, 1.567; 95% CI, 0.912 to -2.693). CONCLUSION Compared with MCT/LCT, SMOF can reduce the risk for PN-associated cholestasis and metabolic bone disease of prematurity in very preterm infants and has a negative effect on growth velocity but has no effect on the incidence of EUGR.
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Affiliation(s)
- Zhu-Xin Zhang
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China; Xiamen Key Laboratory Of Perinatal-Neonatal Infection, Xiamen, China; Xiamen Clinical Research Center for Perinatal Medicine, Xiamen, China
| | - Qing Yang
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China; Xiamen Key Laboratory Of Perinatal-Neonatal Infection, Xiamen, China; Xiamen Clinical Research Center for Perinatal Medicine, Xiamen, China
| | - Wei Shen
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China; Xiamen Key Laboratory Of Perinatal-Neonatal Infection, Xiamen, China; Xiamen Clinical Research Center for Perinatal Medicine, Xiamen, China
| | - Si-Yu Song
- Department of Neonatology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Dong Yang
- Department of Neonatology, Northwest Women's and Children's Hospital, Xian, Shanxi, China
| | - Shi-Rong Song
- Department of Neonatology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yi-Jia Zhang
- Department of Pediatrics, Peking University Third Hospital, Beijing, China
| | - Jiang-Biao Xie
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China; Xiamen Key Laboratory Of Perinatal-Neonatal Infection, Xiamen, China; Xiamen Clinical Research Center for Perinatal Medicine, Xiamen, China
| | - Li-Xia Tang
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China; Xiamen Key Laboratory Of Perinatal-Neonatal Infection, Xiamen, China; Xiamen Clinical Research Center for Perinatal Medicine, Xiamen, China
| | - Juan Kong
- Department of Neonatology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Rui-Miao Bai
- Department of Neonatology, Northwest Women's and Children's Hospital, Xian, Shanxi, China
| | - Wen-Ting Yu
- Department of Neonatology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Juan Zhang
- Department of Pediatrics, Peking University Third Hospital, Beijing, China
| | - Xiao-Mei Tong
- Department of Pediatrics, Peking University Third Hospital, Beijing, China
| | - Fan Wu
- Department of Neonatology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhan-Kui Li
- Department of Neonatology, Northwest Women's and Children's Hospital, Xian, Shanxi, China
| | - Jian Mao
- Department of Neonatology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xin-Zhu Lin
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China; Xiamen Key Laboratory Of Perinatal-Neonatal Infection, Xiamen, China; Xiamen Clinical Research Center for Perinatal Medicine, Xiamen, China.
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Herrera E, Ortega-Senovilla H. Dietary Implications of Polyunsaturated Fatty Acids during Pregnancy and in Neonates. Life (Basel) 2023; 13:1656. [PMID: 37629513 PMCID: PMC10455977 DOI: 10.3390/life13081656] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/24/2023] [Accepted: 07/27/2023] [Indexed: 08/27/2023] Open
Abstract
Certain limitations exist for animals to modify fatty acid changes. Besides the role of arachidonic acid (AA), docosahexaenoic acid (DHA) and other 20-carbon long-chain polyunsaturated fatty acids (LCPUFAs) for the synthesis of inflammatory mediators as eicosanoids, different LCPUFAs have many other effects, including their abilities to regulate gene expression and downstream events. LCPUFAs are susceptible to autoxidation, which is prevented by the action of antioxidants in the form of enzymes like superoxide dismutases, catalases and peroxidases, as well as antioxidant compounds that protect against oxidation or repair the damage caused. Under normal conditions, the fetus needs both essential fatty acids (EFAs) and LCPUFAs, which are obtained from its mother by placental transfer. In early pregnancy, dietary derived fatty acids are accumulated in maternal adipose tissue. However, during late pregnancy, corresponding to the period of the highest fetal growth, maternal adipose tissue becomes catabolic and LCPUFAs are released into the circulation by adipose lipolytic activity. The released LCPUFAs are taken up by maternal liver to be esterified and released back to the circulation as triacylglycerides (TAGs) in very-low-density lipoprotein (VLDL) that become available to the placenta to be transferred to the fetus in the form of non-esterified fatty acids (NEFAs). An enhanced adipose tissue lipolysis is maintained around parturition and esterified LCPUFAs are diverted to mammary glands thanks to an increased activity of lipoprotein lipase for milk production. Throughout this process, LCPUFAs become available to the newborn during suckling. The important role of both DHA and AA for the development of the nervous system and for growth has motivated their dietary supplement during different postnatal stages. This has been especially important in preterm infants both because under normal conditions, the fetus acquires most of these fatty acids during late pregnancy, and because the immaturity of the enzyme systems for the synthesis of AA and DHA from their respective EFAs.
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Affiliation(s)
- Emilio Herrera
- Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, Boadilla del Monte, 28660 Madrid, Spain
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Wang YS, Shen W, Yang Q, Lin R, Tang LX, Bai RM, Yang D, Zhang J, Zhang YJ, Yu WT, Song SR, Kong J, Song SY, Mao J, Tong XM, Li ZK, Wu F, Lin XZ. Analysis of risk factors for parenteral nutrition-associated cholestasis in preterm infants: a multicenter observational study. BMC Pediatr 2023; 23:250. [PMID: 37210514 DOI: 10.1186/s12887-023-04068-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 05/10/2023] [Indexed: 05/22/2023] Open
Abstract
BACKGROUND It is proposed that the development of parenteral nutrition-associated cholestasis (PNAC) was significantly associated with preterm birth, low birth weight, infection, etc.; however, the etiology and pathogenesis of PNAC are not fully understood. Most of the studies examining PNAC-associated risk factors were single-center studies with relatively small sample sizes. OBJECTIVE To analyze the risk factors associated with PNAC in preterm infants in China. METHODS This is a retrospective multicenter observational study. Clinical data on the effect of multiple oil-fat emulsions (soybean oil-medium chain triglycerides-olive oil-fish oil, SMOF) in preterm infants were collected from a prospective multicenter randomized controlled study. A secondary analysis was performed in which preterm infants were divided into the PNAC group and the non-PNAC group based on the PNAC status. RESULTS A total of 465 cases very preterm infants or very low birth weight infants were included in the study in which 81 cases were assigned to the PNAC group and 384 cases were assigned to the non-PNAC group. The PNAC group had a lower mean gestational age, lower mean birth weight, longer duration of invasive and non-invasive mechanical ventilation, a longer duration oxygen support, and longer hospital stay (P < 0.001 for all). The PNAC group had higher respiratory distress syndrome, hemodynamically significant patent ductus arteriosus, necrotizing enterocolitis (NEC) with stage II or higher, surgically treated NEC, late-onset sepsis, metabolic bone disease, and extrauterine growth retardation (EUGR) compared to the non-PNAC group (P < 0.05 for all). In contrast with the non-PNAC group, the PNAC group received a higher maximum dose of amino acids and fat emulsion, more medium/long-chain fatty emulsion, less SMOF, had a longer duration of parenteral nutrition, lower rates of breastfeeding, higher incidence of feeding intolerance (FI), more accumulated days to achieve total enteral nutrition, less accumulated days of total calories up to standard 110 kcal/kg/day and slower velocity of weight growth (P < 0.05 for all). Logistic regression analysis indicated that the maximum dose of amino acids (OR, 5.352; 95% CI, 2.355 to 12.161), EUGR (OR, 2.396; 95% CI, 1.255 to 4.572), FI (OR, 2.581; 95% CI, 1.395 to 4.775), surgically treated NEC (OR, 11.300; 95% CI, 2.127 ~ 60.035), and longer total hospital stay (OR, 1.030; 95% CI, 1.014 to 1.046) were independent risk factors for the development of PNAC. SMOF (OR, 0.358; 95% CI, 0.193 to 0.663) and breastfeeding (OR, 0.297; 95% CI, 0.157 to 0.559) were protective factors for PNAC. CONCLUSIONS PNAC can be reduced by optimizing the management of enteral and parenteral nutrition and reducing gastrointestinal comorbidities in preterm infants.
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Affiliation(s)
- Ya-Sen Wang
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen university, Xiamen, 361003, China
- Xiamen key laboratory of perinatal-neonatal infection, (none)Helping to remove the bracketed content, please, Xiamen, China
- Xiamen Clinical Research Center for Perinatal Medicine, (none)Helping to remove the bracketed content, please, Xiamen, China
| | - Wei Shen
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen university, Xiamen, 361003, China
- Xiamen key laboratory of perinatal-neonatal infection, (none)Helping to remove the bracketed content, please, Xiamen, China
- Xiamen Clinical Research Center for Perinatal Medicine, (none)Helping to remove the bracketed content, please, Xiamen, China
| | - Qing Yang
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen university, Xiamen, 361003, China
- Xiamen key laboratory of perinatal-neonatal infection, (none)Helping to remove the bracketed content, please, Xiamen, China
- Xiamen Clinical Research Center for Perinatal Medicine, (none)Helping to remove the bracketed content, please, Xiamen, China
| | - Rong Lin
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen university, Xiamen, 361003, China
- Xiamen key laboratory of perinatal-neonatal infection, (none)Helping to remove the bracketed content, please, Xiamen, China
- Xiamen Clinical Research Center for Perinatal Medicine, (none)Helping to remove the bracketed content, please, Xiamen, China
| | - Li-Xia Tang
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen university, Xiamen, 361003, China
- Xiamen key laboratory of perinatal-neonatal infection, (none)Helping to remove the bracketed content, please, Xiamen, China
- Xiamen Clinical Research Center for Perinatal Medicine, (none)Helping to remove the bracketed content, please, Xiamen, China
| | - Rui-Miao Bai
- Department of Neonatology, Northwest Women and Children's Hospital, Xian, 710061, China
| | - Dong Yang
- Department of Neonatology, Northwest Women and Children's Hospital, Xian, 710061, China
| | - Juan Zhang
- Department of Pediatrics, Peking University Third Hospital, Beijing, 100191, China
| | - Yi-Jia Zhang
- Department of Pediatrics, Peking University Third Hospital, Beijing, 100191, China
| | - Wen-Ting Yu
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, 110000, China
| | - Shi-Rong Song
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, 110000, China
| | - Juan Kong
- Department of Neonatology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, Guangdong, China
| | - Si-Yu Song
- Department of Neonatology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, Guangdong, China
| | - Jian Mao
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, 110000, China
| | - Xiao-Mei Tong
- Department of Pediatrics, Peking University Third Hospital, Beijing, 100191, China
| | - Zhan-Kui Li
- Department of Neonatology, Northwest Women and Children's Hospital, Xian, 710061, China
| | - Fan Wu
- Department of Neonatology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, Guangdong, China
| | - Xin-Zhu Lin
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen university, Xiamen, 361003, China.
- Xiamen key laboratory of perinatal-neonatal infection, (none)Helping to remove the bracketed content, please, Xiamen, China.
- Xiamen Clinical Research Center for Perinatal Medicine, (none)Helping to remove the bracketed content, please, Xiamen, China.
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Wang F, Wang G, Li W, Xu C, Zeng Z, Zhou Y. Analysis of serum metabolism in premature infants before and after feeding using GC-MS and the relationship with necrotizing enterocolitis. Biomed Chromatogr 2023; 37:e5505. [PMID: 36093571 PMCID: PMC10078300 DOI: 10.1002/bmc.5505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 08/27/2022] [Accepted: 09/08/2022] [Indexed: 02/05/2023]
Abstract
Preterm birth and enteral feeding are two main factors leading to necrotizing enterocolitis (NEC). The metabolomics of preterm infants before and after feeding can provide a basis for the prediction of NEC. Using the method of cross-sectional study, the mode was established with the serum samples of 19 premature infants at birth and after feeding as the control group. The serum was analyzed using GC-MS. Chemometric analysis includes principal component analysis, partial least squares-discriminant analysis, and orthogonal partial least squares-discriminant analysis. Spectral separation of serum metabolites occurred in premature infants before and after feeding. The levels of xylose, d-talose, phosphoglycolic acid, maleimide, l-gulonolactone, maleic acid, β-hydroxypyruvate, itaconic acid, and pantothenic acid in the serum of premature infants after feeding were significant in both multidimensional and single-dimensional modes (variable importance in projection >2, P < 0.01). There was a moderate correlation between total bilirubin and l-gulonolactone and β-hydroxypyruvate (0.8 > r > 0.5). Maleimide, maleic acid, and itaconic acid have diagnostic value (area under the curve >0.9). The results indicated that serum metabolism of preterm infants changes significantly after feeding. Some metabolites have potential value in predicting NEC.
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Affiliation(s)
- Fusheng Wang
- Department of Pediatric SurgerySecond Affiliated Hospital of Shantou University Medical College Shantou China
| | - Guanghuan Wang
- Department of Pediatric SurgerySecond Affiliated Hospital of Shantou University Medical CollegeShantouChina
| | - Weizhong Li
- Department of NeonatologySecond Affiliated Hospital of Shantou University Medical CollegeShantouChina
| | - Chenbin Xu
- Department of Pediatric SurgerySecond Affiliated Hospital of Shantou University Medical CollegeShantouChina
| | - Zailin Zeng
- Department of Pediatric SurgerySecond Affiliated Hospital of Shantou University Medical CollegeShantouChina
| | - Yongcui Zhou
- Reproductive Medicine CentreFirst Affiliated Hospital of Shantou University Medical CollegeShantouChina
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8
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Goulet O, Lamazière A, Abi Nader E, Talbotec C, Wolf C, Lambe C. Erythrocyte fatty acid membrane composition in children on long-term parenteral nutrition enriched with ω-3 fatty acids. Am J Clin Nutr 2022; 115:422-431. [PMID: 34582547 DOI: 10.1093/ajcn/nqab263] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 07/19/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Composite lipid emulsions containing soybean oil (30%), medium-chain triglycerides (30%), olive oil (25%), and fish oil (15%) (SMOF) are now widely used. OBJECTIVES We aimed to evaluate the tolerance, the efficiency, and the erythrocyte fatty acid (FA) profile for children on long-term home parenteral nutrition (HPN) receiving a composite fish oil-based emulsion (FOLE). METHODS At baseline, children (n = 46) with severe intestinal failure highly dependent on parenteral nutrition (PN) for ≥1 y were included in the study when they had received the composite FOLE for >6 mo. Out of this baseline group, only 25 children remained highly PN-dependent (SMOF1, n = 25) and could be assessed a second time, 2.4 y later (SMOF2, n = 25). An independent control group ("weaned off PN" group; n = 24) included children who had been weaned off PN for >2 y (median: 4 y). RBC-FA composition was established by GC-MS. Growth parameters, plasma citrulline, conjugated bilirubin, FA profiles, and the Holman ratio (20:3ω-9/20:4ω-6) were compared between groups. RESULTS No difference for growth parameters, citrulline, and bilirubin was observed between the SMOF groups after 2.4 y (0.2 < P < 0.8). The weaned-off group did not differ from the SMOF groups for growth parameters (0.2 < P < 0.4) but citrulline was higher (P < 0.0001) and conjugated bilirubin lower (P < 0.01). The composite FOLE induced higher proportions of EPA (20:5n-3) (8.4% ± 2.9%) and DHA (22:6n-3) (11.7% ± 2.2%) than what was observed in weaned-off children (0.8% ± 0.4% and 6.6% ± 2.3%, respectively) but lower proportions of arachidonic acid (20:4n-6). However, the Holman ratio did not vary between groups (P = 0.9), whereas the PUFA concentrations varied widely. CONCLUSIONS Long-term use of the composite FOLE was well tolerated in HPN-dependent children. The RBC-FA profile alterations were consistent with the ω-3 PUFA-enriched composition of this emulsion without evidence of essential FA deficiency.
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Affiliation(s)
- Olivier Goulet
- Department of Pediatric Gastroenterology, Hepatology, and Nutrition; Necker-Enfants Malades Hospital; University of Paris; Paris Descartes School of Medicine, Paris, France
| | - Antonin Lamazière
- Mass Spectrometry and Lipid Metabolism Laboratory, Research Center of Saint Antoine, Sorbonne University, Clinical Metabolomics Department, Sorbonne University, Research Center of Saint Antoine, DMU BioGeM, AP-HP, Paris, France
| | - Elie Abi Nader
- Department of Pediatric Gastroenterology, Hepatology, and Nutrition; Necker-Enfants Malades Hospital; University of Paris; Paris Descartes School of Medicine, Paris, France
| | - Cécile Talbotec
- Department of Pediatric Gastroenterology, Hepatology, and Nutrition; Necker-Enfants Malades Hospital; University of Paris; Paris Descartes School of Medicine, Paris, France
| | - Claude Wolf
- Mass Spectrometry and Lipid Metabolism Laboratory, Research Center of Saint Antoine, Sorbonne University, Clinical Metabolomics Department, Sorbonne University, Research Center of Saint Antoine, DMU BioGeM, AP-HP, Paris, France
| | - Cécile Lambe
- Department of Pediatric Gastroenterology, Hepatology, and Nutrition; Necker-Enfants Malades Hospital; University of Paris; Paris Descartes School of Medicine, Paris, France
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9
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Zou TT, Li JR, Zhu Y, Wan CM, Liao Q. Fish oil-containing lipid emulsions prevention on parenteral nutrition-associated cholestasis in very low birth weight infants: a meta-analysis. World J Pediatr 2022; 18:463-471. [PMID: 35325398 PMCID: PMC9205820 DOI: 10.1007/s12519-022-00536-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/27/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND The effect of fish oil-containing lipid emulsions on preventing parenteral nutrition-associated cholestasis (PNAC) in very low birth weight (VLBW) infants is not known. Thus, we conducted a meta-analysis to identify any prevention effect. METHODS PubMed, EMBASE, and CENTRAL were searched up to 26 January 2021 for studies related to the preventive effect of fish oil-containing lipid emulsions and fish oil-free lipid emulsions on cholestasis in VLBW infants. Revman 5.3 was used to synthesize the results. A fixed-effect model was used to summarize the data when the heterogeneity was non-significant (I2 < 50%), and a random-effects model was used when the heterogeneity was significant (I2 > 50%). RESULTS Of 728 articles, 11 randomized controlled trials met the inclusion criteria. The meta-analysis indicated that fish oil-containing lipid emulsion reduced the occurrence of PNAC significantly with risk ratio (RR) = 0.53, 95% confidence interval (CI) 0.36-0.80, P = 0.002. The heterogeneity was non-significant with I2 = 23%. Subgroup analysis based on parenteral nutrition duration and median birth weight was performed. The synthesis results for patients with parenteral nutrition duration exceeding 14 days revealed I2 = 35% (P = 0.15) and pooled RR = 0.47, 95% CI 0.30-0.73, P = 0.0008; and for patients with duration less than 14 days revealed I2 = 0% (P = 0.72) and pooled RR = 1.14, 95% CI 0.39-3.35, P = 0.81. The synthesis for patients with birth weight more than 1000 g revealed I2 = 0% (P = 0.41) and pooled RR = 0.55, 95% CI 0.26-1.18, P = 0.12; and for patients with birth weight below 1000 g revealed I2 = 44% (P = 0.11) and pooled RR = 0.53, 95% CI 0.33-0.85, P = 0.009. CONCLUSIONS The fish oil-containing lipid emulsion can reduce the occurrence of PNAC in VLBW infants based on the available original randomized controlled trial studies, especially for patients with parenteral nutrition duration exceeding 14 days and extremely low birth weight infants. Future studies should be performed before a definitive conclusion can be established.
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Affiliation(s)
- Ting-Ting Zou
- grid.461863.e0000 0004 1757 9397Department of Pediatric Infectious Diseases, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, 610041 China
| | - Jin-Rong Li
- Department of Child Healthcare, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, 610041, China.
| | - Yu Zhu
- grid.461863.e0000 0004 1757 9397Department of Pediatric Infectious Diseases, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, 610041 China
| | - Chao-Min Wan
- grid.461863.e0000 0004 1757 9397Department of Pediatric Infectious Diseases, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, 610041 China
| | - Qiong Liao
- Department of Pediatric Infectious Diseases, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, 610041, China.
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10
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The effect of different intravenous lipids on free bilirubin levels in premature infants. Eur J Clin Nutr 2021; 76:879-882. [PMID: 34853414 DOI: 10.1038/s41430-021-01049-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 10/28/2021] [Accepted: 11/12/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Intravenous lipid emulsions are commonly used as a part of parenteral nutrition in premature infants. The potential bilirubin-displacing effects of high free fatty acid (FFA) levels during lipid infusions are known. Levels of free bilirubin (FB) predict the risk of bilirubin neurotoxicity more accurately than indirect serum bilirubin levels. In the present study, we decided to compare the effect of two different lipid solutions on free bilirubin and free fatty acids levels in premature infants. METHODS Infants were grouped into two groups according to intravenous lipid preparations: Infants in Group 1 received lipid emulsion containing olive oil + soybean oil and Group 2 received containing olive oil + soybean oil + fish oil. The blood samples were gained when lipid intake was 3.5 g/kg/day and FFA and FB levels were analyzed. RESULTS Serum FFA and FB levels were similar in groups (p = 0.26 and 0.69 respectively). There were significant correlation between serum FFA and FB levels in Group 1 (r = 0.74, p < 0.001) and in Group 2 (r = 0.92, p < 0.001). CONCLUSION Both lipid preparations seem to have similar effects on free bilirubin and free fatty acid levels in premature newborns.
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11
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Zübarioğlu AU, Dursun M. Comparison of Alternative Lipid Emulsions on Morbidities in Very-Low-Birth-Weight Preterms. Indian J Pediatr 2021; 88:905-911. [PMID: 33860883 DOI: 10.1007/s12098-021-03691-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 02/02/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To compare clinical outcomes of using different alternative lipid emulsions for longer durations in babies who are at high risk for preterm morbidities. METHODS Preterm infants born ≤ 30 wk receiving SMOFlipid versus Clinoleic with longer durations (≥ 14 d) were included in this retrospective study. The authors compared demographic features, clinical applications, and morbidities between epochs: epoch 1 (Clinoleic, July 2017-June 2018) versus epoch 2 (SMOFlipid, July 2018-June 2019). RESULTS A total of 91 infants were included in the study. In bivariate analysis; moderate bronchopulmonary dysplasia (BPD) (p = 0.000) and composite outcome [BPD, retinopathy of prematurity (ROP) needed treatment, cholestasis and late-onset sepsis and/or mortality] rates were significantly higher (p = 0.043) in Clinoleic group. In multivariate logistic regression analysis, it was found that the type of lipid emulsion used had no significant effect on these morbidities. CONCLUSIONS Since both groups had comparable morbidity and mortality, both lipid emulsions are equally safe in preterm babies requiring parenteral nutrition.
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Affiliation(s)
- Adil Umut Zübarioğlu
- Medical Faculty, Neonatal Intensive Care Unit, Istanbul Yeni Yuzyıl University, Gaziosmanpasa, 34245, Istanbul, Turkey.
| | - Mesut Dursun
- Medical Faculty, Neonatal Intensive Care Unit, Istanbul Biruni University, Istanbul, Turkey
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12
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[Research advances in the effect of long-chain polyunsaturated fatty acids on neonates]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2021. [PMID: 34266537 PMCID: PMC8292656 DOI: 10.7499/j.issn.1008-8830.2104087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Adequate supply of long-chain polyunsaturated fatty acids (LCPUFAs) is of great importance for neonates, especially preterm infants. In particular, n-3 LCPUFAs and n-6 LCPUFAs play a key role in brain development, immune regulation, and disease prevention. Lack of LCPUFAs may lead to neurodevelopmental impairment, affect the development of neonatal immune system, and result in neonatal diseases. This article reviews related research advances in the physiological function of LCPUFAs and its effect on neonates, so as to provide reference for clinical application.
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Costa M, Losada-Barreiro S, Magalhães J, Monteiro LS, Bravo-Díaz C, Paiva-Martins F. Effects of the Reactive Moiety of Phenolipids on Their Antioxidant Efficiency in Model Emulsified Systems. Foods 2021; 10:foods10051028. [PMID: 34068499 PMCID: PMC8150906 DOI: 10.3390/foods10051028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/23/2021] [Accepted: 04/30/2021] [Indexed: 01/02/2023] Open
Abstract
Our previous research was focused on the effects of hydrophobicity on the antioxidant (AO) efficiency of series of homologous antioxidants with the same reactive moieties. In this work we evaluate the antioxidant efficiency of hydrophobic phenolipids in 4:6 olive oil-in-water emulsions, with different phenolic moieties (derived from caffeic, 4-hydroxycinnamic, dihydrocaffeic acids, tyrosol and hydroxytyrosol), with alkyl chains of 8 and 16 carbons, and compare the antioxidant efficiency with that of the parent compounds. All catecholic phenolipids, in particular the C8 derivatives, have proven to be better antioxidants for the oxidative protection of emulsions than their parental compounds with octyl dihydrocafffeate being the most efficient (16-fold increase in relation to the control). To understand the importance of some factors on the antioxidant efficiency of compounds in emulsions, Pearson’s correlation analysis was carried out between antioxidant activity and the first anodic potential (Epa), reducing capacity (FRAP value), DPPH radical scavenging activity (EC50) and the concentration of antioxidants in each region of the emulsified system. Results confirm the importance of the effective concentration of AOs in the interfacial region (AOI) (ρ = 0.820) and of the Epa (ρ = −0.677) in predicting their antioxidant efficiency in olive oil-in-water emulsions.
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Affiliation(s)
- Marlene Costa
- REQUIMTE/LAQV, Department of Chemistry and Biochemistry, Faculty of Sciences, University of Porto, Campo Alegre 687, 4169-007 Porto, Portugal; (M.C.); (S.L.-B.)
| | - Sonia Losada-Barreiro
- REQUIMTE/LAQV, Department of Chemistry and Biochemistry, Faculty of Sciences, University of Porto, Campo Alegre 687, 4169-007 Porto, Portugal; (M.C.); (S.L.-B.)
- Department of Physical-Chemistry, Faculty of Chemistry, Universidade de Vigo, 36310 Vigo, Spain;
| | - Júlia Magalhães
- REQUIMTE/LAQV, Department of Chemical Engineering, Faculty of Engineering, University of Porto, 4200-465 Porto, Portugal;
| | - Luís S. Monteiro
- Chemistry Centre, University of Minho, Gualtar, 4710-057 Braga, Portugal;
| | - Carlos Bravo-Díaz
- Department of Physical-Chemistry, Faculty of Chemistry, Universidade de Vigo, 36310 Vigo, Spain;
| | - Fátima Paiva-Martins
- REQUIMTE/LAQV, Department of Chemistry and Biochemistry, Faculty of Sciences, University of Porto, Campo Alegre 687, 4169-007 Porto, Portugal; (M.C.); (S.L.-B.)
- Correspondence:
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14
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Wang J, Micic D. Hepatobiliary Manifestations of Short Bowel Syndrome and Intestinal Failure-Associated Liver Disease. Clin Liver Dis (Hoboken) 2021; 17:297-300. [PMID: 33968392 PMCID: PMC8087921 DOI: 10.1002/cld.1053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/31/2020] [Accepted: 10/11/2020] [Indexed: 02/04/2023] Open
Affiliation(s)
- Jennifer Wang
- Department of Internal MedicineSection of Gastroenterology, Hepatology and NutritionUniversity of Chicago MedicineChicagoIL
| | - Dejan Micic
- Department of Internal MedicineSection of Gastroenterology, Hepatology and NutritionUniversity of Chicago MedicineChicagoIL
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Hellmann H, Goyer A, Navarre DA. Antioxidants in Potatoes: A Functional View on One of the Major Food Crops Worldwide. Molecules 2021; 26:2446. [PMID: 33922183 PMCID: PMC8122721 DOI: 10.3390/molecules26092446] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/07/2021] [Accepted: 04/19/2021] [Indexed: 12/14/2022] Open
Abstract
With a growing world population, accelerating climate changes, and limited arable land, it is critical to focus on plant-based resources for sustainable food production. In addition, plants are a cornucopia for secondary metabolites, of which many have robust antioxidative capacities and are beneficial for human health. Potato is one of the major food crops worldwide, and is recognized by the United Nations as an excellent food source for an increasing world population. Potato tubers are rich in a plethora of antioxidants with an array of health-promoting effects. This review article provides a detailed overview about the biosynthesis, chemical and health-promoting properties of the most abundant antioxidants in potato tubers, including several vitamins, carotenoids and phenylpropanoids. The dietary contribution of diverse commercial and primitive cultivars are detailed and document that potato contributes much more than just complex carbohydrates to the diet. Finally, the review provides insights into the current and future potential of potato-based systems as tools and resources for healthy and sustainable food production.
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Affiliation(s)
- Hanjo Hellmann
- School of Biological Sciences, Washington State University, Pullman, WA 99164, USA
| | - Aymeric Goyer
- Hermiston Agricultural Research and Extension Center, Department of Botany and Plant Pathology, Oregon State University, Hermiston, OR 97838, USA;
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16
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Costa M, Losada-Barreiro S, Paiva-Martins F, Bravo-Díaz C. Polyphenolic Antioxidants in Lipid Emulsions: Partitioning Effects and Interfacial Phenomena. Foods 2021; 10:539. [PMID: 33807705 PMCID: PMC8001919 DOI: 10.3390/foods10030539] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/26/2021] [Accepted: 02/24/2021] [Indexed: 02/07/2023] Open
Abstract
The autoxidation of lipids in complex systems such as emulsions or biological membranes, although known to occur readily and to be associated with important pathological events, is lacking in quantitative data in spite of the huge efforts that have been made in attempting to unravel the complex mechanisms of lipid oxidation and its inhibition by antioxidants. Lipids are present as oil-in-water emulsions in many foods and pharmaceutical formulations, and the prevalent role of the interfacial region is critical to understand the antioxidant behavior and to correctly interpret antioxidant efficiencies. The aim of this review is to summarize the current knowledge on the chemical fate of antioxidants before they react with peroxyl radicals. Many researchers highlighted the predominant role of interfaces, and although some attempts have been made to understand their role, in most instances, they were essentially qualitative and based on putative hypotheses. It is only recently that quantitative reports have been published. Indeed, knowledge on the effects of relevant experimental variables on the effective concentrations of antioxidants is necessary for a successful design of alternate, effective antioxidative solutions.
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Affiliation(s)
- Marlene Costa
- REQUIMTE-LAQV, Departamento de Química e Bioquímica, Faculdade de Ciências, Universidade do Porto, 4169-007 Porto, Portugal; (M.C.); (S.L.-B.); (F.P.-M.)
| | - Sonia Losada-Barreiro
- REQUIMTE-LAQV, Departamento de Química e Bioquímica, Faculdade de Ciências, Universidade do Porto, 4169-007 Porto, Portugal; (M.C.); (S.L.-B.); (F.P.-M.)
- Department of Physical Chemistry, Faculty of Chemistry, Universidad de Vigo, 36200 Vigo, Spain
| | - Fátima Paiva-Martins
- REQUIMTE-LAQV, Departamento de Química e Bioquímica, Faculdade de Ciências, Universidade do Porto, 4169-007 Porto, Portugal; (M.C.); (S.L.-B.); (F.P.-M.)
| | - Carlos Bravo-Díaz
- Department of Physical Chemistry, Faculty of Chemistry, Universidad de Vigo, 36200 Vigo, Spain
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17
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Deshpande GC, Cai W. Use of Lipids in Neonates Requiring Parenteral Nutrition. JPEN J Parenter Enteral Nutr 2021; 44 Suppl 1:S45-S54. [PMID: 32049399 DOI: 10.1002/jpen.1759] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 11/19/2019] [Accepted: 11/20/2019] [Indexed: 12/19/2022]
Abstract
Neonates have limited antioxidative capacity and are at increased risk of infection and inflammation-a situation that is exacerbated in preterm neonates. Together, oxidative stress and inflammation are implicated in many serious conditions affecting neonates, such as bronchopulmonary dysplasia and periventricular leukomalacia. Neonates requiring parenteral nutrition have certain nutritional requirements. For example, very long-chain ω-3 polyunsaturated fatty acids (PUFAs) such as docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) are regarded as conditionally essential with critical roles during early retinal and brain development, and may also have other benefits such as anti-inflammatory effects. Because of these factors, the choice of lipid emulsion used as part of parenteral nutrition support may influence clinical outcomes in neonates. There are concerns that lipid emulsions based purely on soybean oil may increase lipid peroxidation, oxidative stress, and inflammation because of their high ω-6 PUFA and low ω-3 PUFA concentrations. Composite fish-oil containing lipid emulsions may provide advantages for neonates owing to their high DHA and EPA content and high antioxidant (α-tocopherol) levels. Here, we discuss clinical trials of lipid emulsions in preterm and term neonatal populations, with a particular emphasis on markers of oxidative stress and DHA and EPA levels. Olive oil/soybean oil lipid emulsions have shown few advantages in neonates over other lipid emulsions. However, compared with either pure soybean or soybean/olive-oil based emulsions, composite fish-oil containing lipid emulsions reduce oxidative stress/lipid peroxidation and also increase DHA and EPA levels. These advantages may translate into clinical benefits for neonates requiring parenteral nutrition.
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Affiliation(s)
- Girish C Deshpande
- Neonatal NICU, Nepean Hospital, Kingswood, NSW, Australia
- Sydney Medical School, Nepean, University of Sydney, Australia
| | - Wei Cai
- Department of Pediatric Surgery, Division of Pediatric Gastroenterology and Nutrition, Xin Hua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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18
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Martindale RG, Berlana D, Boullata JI, Cai W, Calder PC, Deshpande GH, Evans D, Garcia-de-Lorenzo A, Goulet OJ, Li A, Mayer K, Mundi MS, Muscaritoli M, Pradelli L, Rosenthal M, Seo JM, Waitzberg DL, Klek S. Summary of Proceedings and Expert Consensus Statements From the International Summit "Lipids in Parenteral Nutrition". JPEN J Parenter Enteral Nutr 2021; 44 Suppl 1:S7-S20. [PMID: 32049392 DOI: 10.1002/jpen.1746] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 09/24/2019] [Accepted: 10/25/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND The 2018 Lipids in Parenteral Nutrition summit involved a panel of experts in clinical nutrition, lipid metabolism, and pharmacology, to assess the current state of knowledge and develop expert consensus statements regarding the use of intravenous lipid emulsions in various patient populations and clinical settings. The main purpose of the consensus statements is to assist healthcare professionals by providing practical guidance on common clinical questions related to the provision of lipid emulsions as part of parenteral nutrition (PN). METHODS The summit was designed to allow interactive discussion and consensus development. The resulting consensus statements represent the collective opinion of the members of the expert panel, which was informed and supported by scientific evidence and clinical experience. RESULTS The current article summarizes the key discussion topics from the summit and provides a set of consensus statements designed to complement existing evidence-based guidelines. Lipid emulsions are a major component of PN, serving as a condensed source of energy and essential fatty acids. In addition, lipids modulate a variety of biologic functions, including inflammatory and immune responses, coagulation, and cell signaling. A growing body of evidence suggests that lipid emulsions containing ω-3 fatty acids from fish oil confer important clinical benefits via suppression of inflammatory mediators and activation of pathways involved in the resolution of inflammation. CONCLUSIONS This article provides a set of expert consensus statements to complement formal PN guideline recommendations.
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Affiliation(s)
- Robert G Martindale
- Department of Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - David Berlana
- Pharmacy Service, Vall d'Hebron Barcelona Hospital Campus and Department of Nutrition, University of Barcelona, Barcelona, Spain
| | - Joseph I Boullata
- Department of Nutrition Sciences, Drexel University, Philadelphia, Pennsylvania, USA.,Clinical Nutrition Support Services, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Wei Cai
- Department of Pediatric Surgery, Division of Pediatric Gastroenterology and Nutrition, Xin Hua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Philip C Calder
- Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK
| | - Girish H Deshpande
- Neonatal NICU, Nepean Hospital, Kingswood, NSW, Australia.,Sydney Medical School, Nepean, University of Sydney, Australia
| | - David Evans
- Department of Surgery, Ohio State University Medical Center, Columbus, Ohio, USA
| | | | - Olivier J Goulet
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Intestinal Failure Rehabilitation Center, National Reference Center for Rare Digestive Diseases, Hospital Necker-Enfants Malades, University of Paris-Descartes, Paris, France
| | - Ang Li
- Department of General Surgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Konstantin Mayer
- Vidia Kliniken Karlsruhe, Medizinische Klinik IV, Karlsruhe, Germany
| | - Manpreet S Mundi
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Martin Rosenthal
- Department of Surgery, Division of Trauma and Acute Surgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Jeong-Meen Seo
- Division of Pediatric Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Dan L Waitzberg
- Department of Gastroenterology, Lim 35, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Stanislaw Klek
- Department of General and Oncology Surgery, Intestinal Failure Unit, Stanley Dudrick's Memorial Hospital, Skawina, Poland
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Abstract
Oxidative stress (OS) plays a key role in the pathophysiology of preterm infants. Accurate assessment of OS remains an analytical challenge that has been partially addressed during the last few decades. A plethora of approaches have been developed to assess preterm biofluids to demonstrate a link postnatally with preterm OS, giving rise to a set of widely employed biomarkers. However, the vast number of different analytic methods and lack of standardization hampers reliable comparison of OS-related biomarkers. In this chapter, we discuss approaches for the study of OS in prematurity with respect to methodologic considerations, the metabolic source of different biomarkers and their role in clinical studies.
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20
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New-generation intravenous fat emulsions and bronchopulmonary dysplasia in preterm infants: a systematic review and meta-analysis. J Perinatol 2020; 40:1585-1596. [PMID: 32636446 DOI: 10.1038/s41372-020-0716-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 05/22/2020] [Accepted: 06/25/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Fat emulsion is an important component of parenteral nutrition in premature infants. However, intravenous fat emulsions (IVFE) was reported to be associated with some serious complications, such as bronchopulmonary dysplasia (BPD). Compared to conventional soybean oil-based IVFE, new-generation IVFE may protect against BPD but the results are conflicting. METHODS Relevant literatures search was conducted and the summary effect estimates of odds ratio (OR) and 95% confidence interval (CI) were calculated with fixed-effects models. RESULTS Of 22 studies involving 3781 infants were selected in this study and BPD was reported as part of the included studies. The pooled estimate for 13 studies, comparing administration of new-generation IVFE with conventional IVFE, indicated that new-generation IVFE was not associated with a reduced risk of BPD in preterm infants, compared with conventional IVFE (OR 0.96; 95% CI 0.80-1.14); the pooled estimate for 18 studies, comparing administration of fish oil-containing IVFE with non-fish oil IVFE, indicated that fish oil-containing IVFE has no protective effect against the occurrence of BPD in preterm infants (OR 0.88; 95% CI 0.71-1.08). CONCLUSIONS There is no evidence to support that the new-generation IVFEs could prevent the incidence of BPD or fish oil-containing IVFEs could show a beneficial effect to BPD in premature infants.
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21
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Khalaf RT, Sokol RJ. New Insights Into Intestinal Failure-Associated Liver Disease in Children. Hepatology 2020; 71:1486-1498. [PMID: 32003009 PMCID: PMC8245203 DOI: 10.1002/hep.31152] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 01/07/2020] [Indexed: 12/26/2022]
Abstract
Development of intestinal failure-associated liver disease (IFALD) is a common complication of long-term parenteral nutrition (PN) in children and adults. The molecular and cellular mechanisms and the phases of IFALD are now being delineated. Components of PN lipid emulsions, including plant sterols, interact with hepatic innate immune activation promoted by products of gut bacterial overgrowth/dysbiosis and altered intestinal barrier function (gut-liver axis) and by episodes of sepsis to cause cholestasis and IFALD. New therapeutic strategies, including modifications of intravenous lipid emulsions to reduce pro-inflammatory fatty acids and plant sterol content, can lower the risk of IFALD, reverse cholestasis, and reduce complications, although the significance of persisting hepatic fibrosis is unknown. This review will provide an update on advances in the pathogenesis of IFALD, newer therapeutic and preventative strategies, and challenges that confront managing patients with IFALD.
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Affiliation(s)
- Racha T Khalaf
- Section of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Digestive Health Institute, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO
| | - Ronald J Sokol
- Section of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Digestive Health Institute, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO
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22
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Fu RH. Selection of lipid emulsions for protection against parenteral nutrition-associated liver disease. Pediatr Neonatol 2019; 60:355-356. [PMID: 31324477 DOI: 10.1016/j.pedneo.2019.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 06/11/2019] [Indexed: 11/18/2022] Open
Affiliation(s)
- Ren-Huei Fu
- Chang Gung Memorial Hospital, Linkou, Department of Pediatric, Division of Neonatology, Medical Education Research Center, Taoyuan, Taiwan.
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